Provider Demographics
NPI:1740925726
Name:RODRIGUEZ, ISABELLE GORMAN (OTR/L)
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:GORMAN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 BIG BEND ST
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-0017
Mailing Address - Country:US
Mailing Address - Phone:915-503-0787
Mailing Address - Fax:
Practice Address - Street 1:3814 BIG BEND ST
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-0017
Practice Address - Country:US
Practice Address - Phone:915-503-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ471902225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist